Provider Demographics
NPI:1285824565
Name:SOZA, VERUTZKA N (DDS)
Entity Type:Individual
Prefix:
First Name:VERUTZKA
Middle Name:N
Last Name:SOZA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52801-1130
Mailing Address - Country:US
Mailing Address - Phone:563-336-3221
Mailing Address - Fax:563-336-3229
Practice Address - Street 1:100 W WALNUT AVE STE 142
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8440
Practice Address - Country:US
Practice Address - Phone:706-529-8427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013956122300000X
IA085031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0080200Medicaid
IA1932193224OtherMEDICAID GROUP NPI #